Provider Demographics
NPI:1952634503
Name:AGAPE ADHC DBA AGAPE CONSUMER DIRECT SERVICES
Entity Type:Organization
Organization Name:AGAPE ADHC DBA AGAPE CONSUMER DIRECT SERVICES
Other - Org Name:AGAPE CONSUMER DIRECT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-581-2252
Mailing Address - Street 1:11220 W FLORISSANT AVE # 118
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6741
Mailing Address - Country:US
Mailing Address - Phone:314-581-2252
Mailing Address - Fax:314-431-3001
Practice Address - Street 1:915 N TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2647
Practice Address - Country:US
Practice Address - Phone:314-581-2252
Practice Address - Fax:314-431-3001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGAPE ADULT DAY HEALTH CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care